Sakakibara M, Tochiki H, Sasaki T, Kunishima T, Nagashima J, Miyake F, Murayama M
Second Department of Internal Medicine, St. Marianna University of Medicine, Kawasaki, Japan.
Jpn Heart J. 1998 Jul;39(4):419-33. doi: 10.1536/ihj.39.419.
The long-term relative benefits of thrombolysis and mechanical reperfusion therapy following acute myocardial infarction (AMI) have not been established. The purpose of this study was to compare left ventricular function, left ventricular remodeling and late outcome after AMI for different reperfusion therapies. Thirty consecutive patients suffering their first anterior wall myocardial infarction with coronary stenoses limited to the left anterior descending coronary artery were studied. They included 10 patients who underwent intracoronary thrombolysis (ICT), 10 who underwent PTCA and 10 who underwent noninterventional medical treatment. All patients underwent coronary angiography (CAG) during the acute phase of AMI and also during the follow-up period, and left ventriculography during the follow-up period and clinical follow-up was performed (mean clinical follow-up period: 53 +/- 31 months). No significant difference in global ejection fraction was noted among the groups, although the end-diastolic volume index (EDVI) in the PTCA group (79.4 +/- 17.5 ml/m2) was significantly smaller than in the noninterventional (106.1 +/- 25.1 ml/m2) and ICT (107.9 +/- 28.3 ml/m2) group (p < 0.05). The regional wall motion index (RWMI) for the anterior region in the PTCA group (-2.7 +/- 0.8) was greater (p < 0.05) than in the noninterventional (-3.4 +/- 0.6) and ICT (-3.3 +/- 0.6) groups. A significant linear correlation was found between EDVI and % diameter stenosis and also between RWMI and % diameter stenosis following reperfusion (p = 0.01). There was no difference in the incidence of cardiac death, nonfatal reinfarction, bypass surgery or congestive heart failure among the groups. Disturbed left ventricular regional wall motion and remodeling benefit most from angioplasty because of prompt restoration of adequate blood flow. However, there was no difference in late outcomes following AMI among the three groups.
急性心肌梗死（AMI）后溶栓和机械再灌注治疗的长期相对益处尚未明确。本研究的目的是比较不同再灌注治疗后AMI患者的左心室功能、左心室重构及远期预后。连续入选30例首次发生前壁心肌梗死且冠状动脉狭窄局限于左前降支的患者。其中10例行冠状动脉内溶栓（ICT），10例行经皮冠状动脉腔内血管成形术（PTCA），10例行非介入药物治疗。所有患者在AMI急性期及随访期均行冠状动脉造影（CAG），随访期行左心室造影并进行临床随访（平均临床随访期：53±31个月）。尽管PTCA组的舒张末期容积指数（EDVI）（79.4±17.5ml/m²）显著小于非介入组（106.1±25.1ml/m²）和ICT组（107.9±28.3ml/m²）（p<0.05），但各组间整体射血分数无显著差异。PTCA组前壁区域的室壁运动指数（RWMI）（-2.7±0.8）大于非介入组（-3.4±0.6）和ICT组（-3.3±0.6）（p<0.05）。再灌注后，EDVI与直径狭窄百分比之间以及RWMI与直径狭窄百分比之间存在显著的线性相关性（p = 0.01）。各组间心源性死亡、非致死性再梗死、搭桥手术或充血性心力衰竭的发生率无差异。由于能迅速恢复充足血流，血管成形术对左心室局部室壁运动紊乱和重构的益处最大。然而，三组AMI后的远期预后无差异。
